Whipple’s endocarditis and biologic response modifiers: a case-based review of an intricate host-pathogen interaction
6 affiliations
- 1Department of Precision Medicine, University of Campania ‘L. Vanvitelli’, Napoli, Italy
- 2Department of Advanced Medical & Surgical Sciences, University of Campania ‘L. Vanvitelli’, Napoli, Italy
- 3Unit of Gastroenterology and Digestive Endoscopy, AORN Ospedali dei Colli-Monaldi Hospital, Napoli, Italy
- 4Unit of Microbiology and Virology, INMI “L. Spallanzani”, Rome, Italy
- 5Unit of Anatomy and Pathological Histology, AORN Ospedali dei Colli-Monaldi Hospital, Napoli, Italy
- 6Unit of Internal Medicine and Transplants, AORN Ospedali dei Colli-Monaldi Hospital, Napoli, Italy
Abstract
Whipple’s disease is a rare and chronic multisystem infectious disorder caused by Tropheryma whipplei. Blood-culture negative infective endocarditis may complicate the course of classical Whipple’s disease or appear as an isolated manifestation. The pathophysiology of this rare and complex disorder is still unclear, and the appropriate therapeutic management is debated. Recent reports have highlighted the role of biologic response modifiers in causing overt disease or in accelerating patient presentation by worsening pre-existing symptoms especially when administered in patients with isolated joint manifestations. In this clinical scenario, we describe the first reported case of classical Whipple’s disease complicated with endocarditis in which patient symptoms were exacerbated by administration of IL-17 inhibitors. The patient presented with a history of long-standing fever and seronegative spondylarthritis and received a diagnosis of native aortic valve blood-culture negative infective endocarditis. Associated gastrointestinal symptoms prompted duodenal endoscopy with histology and molecular biology confirming the diagnosis. The following review provides valuable insights in the pathophysiology, diagnosis, treatment and long-term management of Whipple’s disease and underlies how modern medicine and newer treatment options are shaping the host-pathogen interaction and presentation patterns of infectious diseases.
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BibTeX
@article{bertolino2026whipples,
title = {{Whipple’s endocarditis and biologic response modifiers: a case-based review of an intricate host-pathogen interaction}},
author = {Lorenzo Bertolino and Raffaella Gallo and Anna Maria Carolina Peluso and Fabian Patauner and Oriana Infante and Fabio Luciano and Nathalie Scarpulla and Marcella Sannino and Antonella Vulcano and Luigi Panico and Emanuele Durante-Mangoni},
journal = {Infection},
year = {2026},
month = jun,
doi = {10.1007/s15010-026-02828-5},
url = {https://doi.org/10.1007/s15010-026-02828-5},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Whipple’s endocarditis and biologic response modifiers: a case-based review of an intricate host-pathogen interaction
AU - Lorenzo Bertolino
AU - Raffaella Gallo
AU - Anna Maria Carolina Peluso
AU - Fabian Patauner
AU - Oriana Infante
AU - Fabio Luciano
AU - Nathalie Scarpulla
AU - Marcella Sannino
AU - Antonella Vulcano
AU - Luigi Panico
AU - Emanuele Durante-Mangoni
PY - 2026
DA - 2026/06/03
JO - Infection
DO - 10.1007/s15010-026-02828-5
UR - https://doi.org/10.1007/s15010-026-02828-5
AB - Whipple’s disease is a rare and chronic multisystem infectious disorder caused by Tropheryma whipplei. Blood-culture negative infective endocarditis may complicate the course of classical Whipple’s disease or appear as an isolated manifestation. The pathophysiology of this rare and complex disorder is still unclear, and the appropriate therapeutic management is debated. Recent reports have highlighted the role of biologic response modifiers in causing overt disease or in accelerating patient presentation by worsening pre-existing symptoms especially when administered in patients with isolated joint manifestations. In this clinical scenario, we describe the first reported case of classical Whipple’s disease complicated with endocarditis in which patient symptoms were exacerbated by administration of IL-17 inhibitors. The patient presented with a history of long-standing fever and seronegative spondylarthritis and received a diagnosis of native aortic valve blood-culture negative infective endocarditis. Associated gastrointestinal symptoms prompted duodenal endoscopy with histology and molecular biology confirming the diagnosis. The following review provides valuable insights in the pathophysiology, diagnosis, treatment and long-term management of Whipple’s disease and underlies how modern medicine and newer treatment options are shaping the host-pathogen interaction and presentation patterns of infectious diseases.
SN - 0300-8126
SN - 1439-0973
ER -